The Discovery and Early Development of Insulin

From a Patient's Point of View

Prior to the discovery of insulin severe diabetics were treated primarily by means of a strict diet which inevitably led to starvation if not out and out death from the disease. Children in particular suffered terribly from these severely restricted diets. For example, Leonard Thompson weighed only 65 pounds at the age of 14 when he was admitted to the Toronto General Hospital in December 1921, and was receiving only 450 calories per day. Jim Havens weighed less than 74 pounds at the age of 22, and when Elizabeth Hughes arrived in Toronto she weighed only 45 pounds and could barely walk on her own. After five weeks of treatment her weight had increased by ten pounds, and she was revelling in a 2500 calorie diet which included a pint of cream daily, having endured calorie intakes as low as 300 calories per day during the worst periods of her illness. In private correspondence, accounts in the popular press, and even in scientific journals the miraculous return to life and health of these patients once they received insulin was likened to a miracle.

Once press coverage of the clinical trials began early in 1922 the Toronto group was besieged with requests for insulin. The severe problems with insulin production in Toronto at that time meant that only a very few critically ill patients could be considered for treatment. During the spring and summer of 1922 some of these severely ill diabetics, particularly the children, came to Toronto as Banting's private patients in order to be included in the clinical trials of insulin. The Toronto General Hospital diabetic clinic, under the direction of Dr. Duncan Graham, opened on 21 August and clinics were set up in several other Canadian cities soon afterwards. In the United States respected clinicians such as Dr. Elliott P. Joslin in Boston, Dr. Frederick M. Allen in Morristown, NJ and Dr. Rollin T. Woodyat in Chicago also began successfully to treat patients with insulin manufactured by the Eli Lilly Company. By early 1923 more than 1000 diabetics were being treated by more than 250 physicians in sixty clinics in the United States and Canada.

A selection of documents including letters, patient charts, newspaper clippings, and photographs are viewable here.

The following section gives an overview of some of the earliest patients to be treated during 1922.

Patient: Leonard Thompson
Doctor: Dr. Walter Campbell

Notes:

  • in January 1922, at age 14, Thompson was the first diabetic to receive injections of pancreatic extract, at Dr. Campbell's clinic at Toronto General Hospital; first receiving Banting and Best's preparation on 11 Jan., and then Collip's purified extract on 23 Jan. 
     
  • he lived for 13 years on insulin but died at the age of 27 from complications due to diabetes

Patient: Dr. Joseph A. Gilchrist
Doctor: Dr. F. G. Banting

Notes:

  • Banting's friend and classmate became diabetic in 1917 just after graduation
     
  • on 20 Dec. 1921 he was the first to be treated with pancreatic extract but it was administered by mouth and thus had no beneficial effect
     
  • he received his first insulin injection in February as part of an experimental trial in Banting's and Best's lab, and then began regular treatment 15 May when Connaught insulin was available in sufficient quantity to resume clinical trials
     
  • Gilchrist served as both patient, experimental subject, and physician at the diabetic clinic at the Christie Street Military Hospital in Toronto, testing batches of insulin on himself during the spring and summer of 1922

Patient: James Havens
Doctor: Dr. John R. Williams

Notes:

  • Havens's father, who was Vice-President of Eastman Kodak, and his doctor were successful in obtaining permission to administer insulin to the dying young man in Rochester, NY on 22 May 1922, making Havens the first diabetic to receive insulin in the United States
     
  • Banting himself went to Rochester 26 May when Havens initially did not respond well to treatment
     
  • for a time during the summer of 1922 Havens was the only person outside of a handful of patients in Toronto being treated with insulin
     
  • Havens went on to become a well known artist and printmaker

Patient: Ruth Whitehill
Doctor: Dr. Louis Hamburger

Notes:

  • one of Banting's private patients, an 8 year old who had come from Baltimore to be treated with insulin; receiving her first injection 17 June
     
  • she was able to return home by the end of Sept.

Patient: Myra Blaustein
Doctor: Dr. Louis Hamburger

Notes:

  • another of Dr. Hamburger's patients who had come from Baltimore to be treated with insulin
     
  • she returned home at the same time as Ruth Whitehill

Patient: Teddy Ryder
Doctor: Dr. Morton Ryder

Notes:

  • one of Banting's star patients, referred to as the 'living miracle' in press accounts, who came to Toronto as a 5 year old boy, weighing only 27 pounds, receiving his first injection on 10 July
     
  • the following year he wrote to Banting several times from his home in Connecticut, informing him that "I am a fat boy now and I feel fine"; Banting kept in touch with him through the 1920s and 1930s
     
  • Teddy Ryder lived for over 70 years on insulin, dying at the age of 76

Patient: Charlotte Clarke
Doctor: Dr. L. C. Palmer

Notes:

  • 57 year old Charlotte Clarke received her first injection of insulin at Toronto General Hospital the same day as Teddy Ryder, in preparation for surgery the following day necessitated by gangrene in her ankle
     
  • her leg was amputated above the knee; this was the first major operation performed on a diabetic with the help of insulin; prior to this time diabetics had little chance of surviving surgery
     
  • by August she was learning to use her prosthetic leg

Patient: Elizabeth Hughes
Doctor: Dr. Frederick M. Allen

Notes:

  • daughter of the U.S. Secretary of State Elizabeth was Banting's star patient and the subject of considerable press coverage, receiving her first injection on 17 Aug. and returning home to Washington, DC on 30 Nov.
     
  • the collection contains a series of letters written by Elizabeth to her mother both before and after her treatment by Banting in Toronto which gives a moving account of the life of a diabetic at the time and documents the almost miraculous return to life of this exceptional girl
     
  • she went on to Barnard College, married lawyer William T. Gossett and lived a long and productive life; none of her later friends or associates even knew that she suffered from diabetes; she died in 1981 at the age of 73

Patient: Janet Turnbull
Doctor: Dr. Lichty

Notes:

  • 6 year old Janet Turnbull received her first insulin at Toronto General Hospital on 20 August and was able to return to Pittsburg by 22 Sept.

Patient: Elsie Needham
Doctor: Gladys Boyd

Notes:

  • the first child to recover from a coma as a result of insulin treatment, at the Hospital for Sick Children in Toronto in Oct. 1922
  • by Jan. 1923 she was well enough to resume a normal life and return to school in Galt, Ontario
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From a Patient's Point of View